Central line-associated blood stream infections are avoidable through proper insertion techniques and management of the central line, but they continue to be a common hospital-acquired infection in the United States: an estimated 41,000 CLABSIs occur each year in the U.S., according to the Centers for Disease Control and Prevention.
Many hospitals have taken action to train staff and better maintain central lines to avoid these infections. "Sharing successful process improvement strategies for catheter maintenance is essential to continuing efforts to prevent these serious bloodstream infections," said Jennie Mayfield, BSN, MPH, president of the Association for Professionals in Infection Control and Epidemiology, in a news release.
In that spirit, below is how three hospitals managed to reduce their CLABSI rates dramatically. All information stems from three separate studies, which will be presented June 7 at APIC's 41st Annual Conference.
Texas Health Presbyterian Hospital of Dallas
Infection preventionists at this 800-bed hospital noticed a hospitalwide increase in CLABSIs in 2011. Through an analysis, they pinpointed inadequate catheter maintenance as the culprit — more specifically, employees were not consistently scrubbing the catheter hub with alcohol for 15 seconds prior to accessing the central line.
After trying a multitude of evidence-based strategies to improve catheter maintenance, the infection preventionists received approval to use alcohol-impregnated port protectors on every patient in every unit. These disinfecting caps eliminate the need to scrub the catheter hub prior to accessing the line.
In 10 months after implementing the disinfecting caps hospitalwide, Texas Health Presbyterian Hospital of Dallas saw a 68 percent decrease in CLABSI rates and achieved a total cost savings of $410,000.
However, just using the disinfecting caps is not enough to achieve results. "The alcohol-impregnated port protectors represent one way to protect the line and keep it in a constant state of disinfection, but there's a lot more involved than just adding a cap," said Barbara Danielson, RN, BSN, infection prevention manager at Texas Health Dallas and study author, in a news release. "You have to stay on top of the process."
At Texas Health Dallas, the infection prevention team educated nurse managers and front-line patient care providers and conducted weekly audits of cap use. They also ensured the caps were readily available at every point-of-use.
Loyola University Medical Center
The Maywood, Ill.-based hospital, which has 140 intensive care unit beds, also found success in decreasing CLABSI rates by using disinfecting caps.
The hospital's infection prevention team conducted a three-arm study to compare disinfection caps to a scrub-the-hub intervention. While both led to a decrease in CLABSIs, the scrub-the-hub intervention ended up being less effective: In the last three months of the study, 80 percent of the CLABSIs in the scrub-the-hub intervention were related to a drop-off of adherence to the protocol.
"It became clear that relying solely on the scrub-the-hub method may not be sustainable for many staff," said Marcelina Wawrzyniak, MSN, RN, an infection preventionist at Loyola University Medical Center and the study's author, in a news release. "The alcohol-impregnated caps, by comparison, were vey well received due to their ease of use."
Overall, the hospital saw a 68 percent decrease in the overall number of CLABSIs in one year. This reduced CLABSI-related costs by more than $1 million, according to the study.
UPMC St. Margaret
When UPMC St. Margaret, a 250-bed hospital, decided to stop using disinfecting caps on central lines in August 2012, the Pittsburgh-based hospital saw an increase in CLABSI occurrences. Instead of going back to using the caps, the infection prevention team took a "back to the basics" approach.
This educational approach included tools like videos, talking points, printed cards and an online manual. Topics included scrubbing the hub, proper labeling and dressing and tubing change requirements and techniques.
"Sometimes people can become a bit too reliant on products, like we were with the alcohol caps," said Jenny Bender, MPH, BSN, RN, an infection preventionist at the hospital and the study's author, in a release. "Our staff got so used to having them and letting them do the work for us that we became too relaxed with our good nursing care…As a team, we were able to retrain and reintroduce good practices back into our everyday routine."
Since rolling out the program in May 2013, the hospital achieved zero CLABSIs through November 2013.
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